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How do I get this admission paid?

  1. #1
    Default How do I get this admission paid?
    Medical Coding Books
    Does anyone know of a way to get an admission the day before surgery paid if the decision for surgery came on the subsequent day's visit? I get denials as global since it's the day before but I can't put a -57 on it since that's not when the decision was made. On the other hand, it's not like an admission for a planned surgery since they're doing much more work by ordering tests, etc. to try to determine what the problem is and what to do about it. So, my coding looks like:
    Day 1 99222
    Day 2 99232-57, 47562
    The insurance companies then deny the 99222. Any suggestions or am I stuck?
    Sue Vermette, CPC

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Admission
    Okay ... you'll need to appeal.

    It's not common that a surgeon will admit a patient to the hospital unless the surgeon plans to operate. So if that really was the case, your diagnosis for the first day should NOT be definitive, but rather signs/symptoms.

    NOTE: if your first date documentation says something along line of "will take to OR after lab tests done," or "suspect need for cholestectomy, will re-evaluate in the morning," then your decision for surgery WAS on the first day (even though it was "iffy")

    Hope that helps,

    F Tessa Bartels, CPC, CEMC

  3. #3
    Lightbulb
    Good point! The note says if the pt feels better, they'll hold off on surgery but he was tentatively scheduled for surgery the next day anyway. I was relying on what the doc gave me but after looking at the actual documentation (imagine that!), I like your take on the situation so feel more comfortable putting the -57 on the admit.
    Thanks for the advice!

    Sue
    Sue Vermette, CPC

  4. Default
    Quote Originally Posted by SUEV View Post
    Good point! The note says if the pt feels better, they'll hold off on surgery but he was tentatively scheduled for surgery the next day anyway. I was relying on what the doc gave me but after looking at the actual documentation (imagine that!), I like your take on the situation so feel more comfortable putting the -57 on the admit.
    Thanks for the advice!

    Sue
    Also I was always told that an E&M on the day before the surgery and an E&M done on the day of the surgery, the E&M on the day of sx is not billable only the one on the day before is.
    So I would code the admit w/ 57 and not bill for the subsequent visit on the day of sx.

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